Archive for March, 2010

Digesting the Healthcare Overhaul

March 30th, 2010 by Melanie Matthews

Healthcare’s historical week continued with last Tuesday’s signing by President Barack Obama of the Patient Protection and Affordable Care Act, followed by Thursday’s passage by the House of Representatives of the budget reconciliation bill that tweaked the sweeping healthcare overhaul.

It’s a lot to digest. There is certainly confusion over the one-two punch of the bills; many seek a simpler, streamlined version of the changes. We took some time last week to gauge industry reaction, and found that just over half of 125 respondents to our online survey see the landmark legislation as positive. Respondents also predicted the impact of healthcare reform on care access, delivery and cost and described the steps they’ll take immediately to prepare for immediate and long-term changes spelled out in the bill.

Watch this space next week for an e-summary of the survey results, or e-mail me at pdonovan@hin.com to request your copy.

What is clear is that healthcare reform will reward payors, purchasers and providers for innovations that streamline care delivery and reduce costs. In this week’s Healthcare Business Weekly Update, we launch a new feature — Chart of the Week — to track trends and innovations in healthcare, starting with a look at populations targeted by telehealth.

3-Minute Mental Health Checklist

March 26th, 2010 by Melanie Matthews

In a breakthrough for behavioral health, a new online, three-minute checklist helps to indicate whether a patient has any of four major mental health conditions. I completed this checklist myself in less than three minutes. This could definitely be a valuable diagnostic tool for physicians and provide some insight for patients who may be suffering from certain mental health conditions.

Also in this issue, you will discover if feeling lonely could affect blood pressure as well as how physicians are prescribing certain psychiatric drugs.

How Healthcare Blunts Financial Impact of Uninsured

March 22nd, 2010 by Melanie Matthews

According to a 2007 Commonwealth Fund study, nearly 25 million Americans are underinsured and can’t close the gap between their insurance coverage and their medical bills. At the beginning of 2009, the number of uninsured Americans was estimated at 52 million. In response to a 2009 e-survey, 127 healthcare organizations described how they’re softening the financial blow of the un- and underinsured on their organizations.

Conducted online in May 2009, the survey’s goal was to discover the strategies organizations are using to reduce the financial burden of the uninsured, while making healthcare more affordable to these populations. Through responses provided by 127 healthcare organizations to 24 multiple choice and open-ended questions, the survey results reveal a tightening of business processes, new and modified product lines and an emphasis on consumer education.

Survey Highlights

  • Of 127 responding healthcare organizations including physicians, hospitals and health plans, 58.5 percent have launched products and/or services to reduce the financial impact of the uninsured and underinsured.
  • Almost one-fourth of the 44 organizations that have not launched products or services for this purpose (22.7 percent) plan to do so in the next 12 months.
  • Nearly 35 percent of all respondents say 5 to 10 percent of their populations are uninsured while 19 percent say their uninsured totals between 11 and 19 percent of their populations.
  • More people are underinsured than uninsured, with about a third (32.5 percent) of respondents noting that 20 percent or more of their populations are underinsured.
  • More than two-fifths of respondents — 42.9 percent — say the programs they have implemented have not helped to blunt the financial impact of the un- and underinsured, but nearly half — 42.9 percent — report a negative financial impact from their efforts.

Key Findings

Physicians:

  • Improving billing, collections and cash handling functions is the top strategy employed by physicians to reduce the financial impact of the uninsured and underinsured on their business, said 75 percent of responding physicians.
  • Three-quarters of responding physicians are discounting primary care to make healthcare more affordable for the uninsured and underinsured.

Hospitals:

  • Nearly all of responding hospitals — 90 percent — are educating the uninsured on policies that provide financial assistance to them in the hopes of reducing the financial impact of care costs for these populations.
  • Almost three-fourths of respondents — 70 percent — are educating patients on policies that provide financial assistance to uninsured and underinsured to try to make healthcare more affordable to these populations.

Health Plans:

  • More than half — 58.8 percent — of responding health plans have seen a reduction in number of employers offering employer-sponsored coverage.
  • Almost half — 43.8 percent — of responding health plans have created a basic coverage health plan to reduce the financial impact of the uninsured and underinsured on their organizations.

Top Three Targets of Employer Health Coaching Programs

March 22nd, 2010 by Melanie Matthews

An analysis of responses by employers to the Healthcare Intelligence Network second annual Health Coaching survey reveals slight differences from those of the overall respondent population — most notably in the areas of coaching focus, delivery methods, population health status improvement, ROI measurement methods and ROI.

The primary focus of health coaching efforts by employers, who constituted almost a fifth of survey respondents, is smoking cessation, as noted by 94.1 percent of responding employers, followed by weight management (82.4 percent) and exercise (76.5 percent).

Telephonic (76.5 percent), online (52.9 percent) and in-person coaching (47.1 percent) were the top three delivery methods of employers that offer health coaching.

Participants to employer coaching programs are identified by HRAs (76.5 percent), self-referrals (58.8 percent) and biometric screening data (35.3 percent.)

A slightly higher percentage of employers (68.8 percent) reported improvements in health status within their populations as compared to the overall population, as well as reduced risks identified by HRAs (43.8 percent).

To measure ROI from health coaching programs, employers chiefly rely on HRAs (76.5 percent), followed by claims data (58.8 percent) and biometric screenings (52.9 percent).

Declining Cancer Mortality

March 22nd, 2010 by Melanie Matthews

Healthy lifestyle changes and timely screenings have contributed to a decline in cancer mortality rates, according to a new study by the American Cancer Society. Learn more about ACS’ findings in this week’s DM Update, as well as the connection between family history and coronary artery disease. And in our prevention story, discover if the use of medical devices at home could help patients and doctors better manage certain chronic conditions.

Top Reasons for Potentially Preventable Readmissions

March 12th, 2010 by Melanie Matthews

Dianne Feeney, associate director of quality initiatives for the Maryland Health Services Cost Review Commission (HSCRC), discusses reasons for potentially preventable readmissions as well as the related costs for these readmissions.

The HSCRC has a list of the top 15 reasons for a potentially preventable readmission (PPR). The first three constitute a big chunk — septicemia, heart failure and chronic obstructive pulmonary disease (COPD). All told, these 15 PPRs represent 42 percent of charges on PPRs for a 30-day readmission time window.

We also have listed the top 15 initial admissions that are followed by one or more PPRs. The top three have changed positions a bit — compared with the reason for the readmission is the initial reason for the admission. Again, the top three are heart failure, COPD and septicemia.

We also looked at the top five PPR reasons for an initial admission of heart failure. We delved down into heart failure because it’s a critical one. The top reasons for readmission in 2007 for 15 and 30 days are heart failure, renal failure, septicemia, respiratory system, ventilator support and pulmonary edema. Those are the heart failure reasons why people come back most frequently.

We then looked at length of stay and charges for initial admissions followed by a PPR. We wanted to make sure we were not seeing a shorter length of stay followed by a readmission — in other words, the patient got out quicker, was too sick and then was readmitted. We’re seeing that with those readmissions, the length of stay is longer in the initial admission for those who are readmitted, not shorter for both 15 and 30 days.

There were 472,380 admissions or candidates for having a subsequent PPR and 31,873 admissions were followed by one or more PPRs. The formula to calculate the PPR rate is as follows: 6.75=31,873/472,380. The admissions that had a readmission go over the candidates for admission. The important thing to recognize is that there are exclusions to patients that are counted in the mix as being candidates. These exclusions are obstetric patients, newborn patients, patients with multiple traumas who are very sick, patients with multiple malignancies and patients with severe immunosuppression, like AIDS. That’s why not every single patient who is admitted is counted in the denominator; we do remove some people that are excluded.

Overall, $430.4 million in the state in 2007 — or almost 200,000 hospital bed days — were related to PPRs in our state. For the 30-day numbers, the impact is $656.9 million in charges out of that $800 billion industry in inpatient care and 303,000 hospital bed days. We’re not talking about small money or small impact.

New Diabetes Risk Factors

March 12th, 2010 by Melanie Matthews

Diabetes affects approximately 8 percent of people in the United States, and adults with diabetes have heart disease death rates two to four times higher than adults without diabetes, according to the American Diabetes Association. In this week’s issue, you will discover how sugar-sweetened drinks are contributing to this problem, along with the link between diabetes, depression and dementia.

You will also learn about two doctors’ prescriptions that could help improve diabetes care.

Reducing Readmissions an Olympian Task

March 8th, 2010 by Melanie Matthews

Although the 2010 Winter Olympics concluded more than a week ago, several athletes are still making headlines. A figure skater, a skeleton racer and a snowboarder will appear in a series of videos from first lady Michelle Obama’s Let’s Move initiative to solve childhood obesity within a generation.

Also out of Canada this week is a new tool to predict a patient’s probability of readmission to the hospital within 30 days. A featured story in this week’s Healthcare Business Weekly Update describes how an individual’s LACE score (devised from Length of stay, Acuity, Comorbidity and ER utilization) can indicate their risk of readmission or death. That’s a gold medal strategy that healthcare organizations can use to reduce costly avoidable hospitalizations, as is a related Maryland initiative to identify reasons for potentially preventable readmissions. This week’s issue provides more details.

Back on U.S. soil, there’s a lot of work going on in medical homes around the country to improve care coordination and delivery. Take our fourth annual Patient-Centered Medical Home survey and see how your efforts stack up against those of your peers. (More than 50 companies have described their programs so far.) Respond by March 31 and you’ll be e-mailed a summary of the survey results.

Disease Management and Demographics

March 8th, 2010 by Melanie Matthews

This week’s issue highlights how location and race can play a part in disease management and the link between sociodemographics and cancer screenings. Also, a CDC report outlines where hospitalizations for heart disease occur the most among the elderly.

Geography affects funding for disease prevention, too. Find out how federal and state budget cuts are affecting the states’ disease prevention efforts.

Fighting Childhood Obesity

March 4th, 2010 by Melanie Matthews

In response to first lady Michelle Obama’s efforts to fight childhood obesity in America, this issue of the DM Update is focused on this epidemic. You will learn whether increased rates of obesity and other chronic conditions in children will improve over time and when efforts to prevent obesity among children should in fact begin.

Also provided in this issue is information about the Partnership for a Healthier America, a new initiative with a goal of solving childhood obesity within a generation.